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Case Reports
. 2025 Feb 4;9(3):ytaf058.
doi: 10.1093/ehjcr/ytaf058. eCollection 2025 Mar.

Endo- and myocarditis as a severe complication of immune-related adverse event treatment: a case report

Lauren Van den Bosch  1 , PieterJan Vanclooster  2 , Jan Van Offenwert  3 , Laure-Anne Teuwen  4 , Constantijn Franssen  1   5
Affiliations
Case Reports

Endo- and myocarditis as a severe complication of immune-related adverse event treatment: a case report

Lauren Van den Bosch et al. Eur Heart J Case Rep. .

Abstract

Background: Disseminated Aspergillus infection is a severe condition in immunocompromised patients. Mortality secondary to cardiac Aspergillus infection remains high.

Case summary: We present a case of a 45-year-old female breast cancer patient who developed Aspergillus fumigatus endocarditis and myocarditis after receiving the immune checkpoint inhibitor (ICI) pembrolizumab. The infection emerged as a complication following the management of a severe immune-related adverse event (irAE) with high doses of immunosuppressants, triggered by the ICI.

Discussion: The use of ICIs and the subsequent treatment of irAEs with immunosuppressants introduce a new subset of immunocompromised patients at risk for fungal infections. While alternative corticosteroid-sparing immune-modulating agents such as biologicals, intravenous immunoglobulins, and disease-modifying anti-rheumatic drugs have been explored, there is lack of prospective studies evaluating their efficacy and safety in this context.

Keywords: Aspergillosis; Breast cancer; Case report; Corticosteroids; Endocarditis; Immune-related adverse event; Myocarditis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Brain magnetic resonance imaging axial T2 view of multiple brain lesions (white arrows) with mass effect and surrounding oedema.
Figure 2
Figure 2
Electrocardiogram showing third-degree atrioventricular block.
Figure 3
Figure 3
Chest computed tomography axial view with contrast-enhancing lesions originating from the left ventricular wall (white arrow) and endomyocardium extending to both left and right ventricular cavities (black arrows).
Figure 4
Figure 4
Transoesophageal echocardiography showing left ventricular wall thickening with inhomogeneous aspect, i.e. basal anteroseptal and anterolateral (black arrow) suspect of myocarditis.
Figure 5
Figure 5
Transthoracic echocardiography parasternal long-axis view with left ventricular wall thickening with inhomogeneous aspect, suspect of myocarditis (black arrows), and a lesion of the mitral valve (white arrow), suspect of endocarditis.
None
See this image and copyright information in PMC

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